Pre-assessment questionnaire

  • About you

  • About the company

  • About your job role

  • Please give us as many details as possible about what your job entails and the environment in which you work.
  • Please post a photo if possible
  • Medical background

  • In the case of DSE chairs, most are built around a mechanism designed to support a user weighing between 7.5 and 23.5 stone (~47.5 – ~150kg) and warrantied accordingly. If you do not wish to disclose your exact weight, we would be grateful if you would indicate whether you are inside/outside of those parameters.
  • Please explain why you have been referred to us for an assessment, as much information as possible is really useful, so if you could explain the issue, the history and what the impact on your work has been. Please feel free to type as much as you want in this area.
  • Think about home and work and give us a brief summary of how you are feeling. For instance, have you changed job recently?
  • This field is for validation purposes and should be left unchanged.